Picture the scene. A pride of seasoned, hard working midwives.  A team meeting. With the big boss, the Head of Midwifery. A chance to talk openly about the issues which affect us. Naturally we have a lot to say. Seriously, she really shouldn’t get us started… We’re not exactly holding our breath though.  While we appreciate her taking the time to meet us, we’ve  been around long enough (not kidding, there’s 200 years of expertise between us) to know that it’s just a formality. It’s a how-are-you exercise where the single acceptable answer is fine-thank-you, followed by her rather predictable speil about how many new (very junior) midwives will be starting soon, how she values our hard work,  how open she is to our feedback and suggestions… Thing is, she’s not wrong. There will be new midwives.  I mean,  sure, we’ll have to teach them everything we know (lucky them!) But statistically speaking, they won’t stay long, not because they can’t hack it, far from it, but because of the usual pressures, namely money and childcare. She does value our hard work, for sure. I mean, she’d like us to do more because you know, needs must, right? Never enough money, never enough midwives… And she’s talking to us now isn’t she? Listening to our feedback, for sure.

So we talk.  We explain that the heavy work load is getting heavier. Because each woman is unique and has her own complex needs. Which we are expected to meet. Because she’s bringing a new human into the world and we’d really like to make that world a safe place. It’s quite a big ask. We’re given one 90 minutes initial booking appointment and 7 or 8 thirty minute follow up appointments to achieve this laudable goal. To be fair, we can achieve minor miracles because we hold keys to many beneficial services, like physiotherapy, counselling, and charitable organisations. But of course, what these new humans (and their mothers) are going to need the most is decent housing and sufficient cash. That level of miracle is beyond us.

We have up to 12 follow-up appointments per day. It’s pretty full on. But it only takes one woman to be running late for our whole precariously-timed day to go horribly awry. Or one woman who bursts onto tears the minute she takes her seat, or one woman who requires extra tests/referrals, or a woman who needs an interpreter, or a woman who’s brought all her other children, or simply a woman who’s a bit chatty! Heaven help us on days when we get a combination of the above. That spells the end of our lunch break before it’s even begun. But we’ll have to start again on time regardless for the afternoon session. And in between appointments, should we have a spare slot, there’s always a stack of emails that need answering. Appointments to reschedule, advice to give, forms to fill out. Skills to sign off with our hard-working students (who are a godsend), new guidelines to assimilate. A myriad of study sessions. And everything we do has to be documented in a manner that will be accessible to other members of the team. Using the new computer software that we’ve all been painstakingly getting to grips with despite truly terrible training.

I know. It sounds like I’m whingeing. I hear it too! And so I don’t blame the Big Boss’s response, her non-verbal one, that is. (Because guess what, I have developed skills akin to mind reading in this job over the years, and I know exactly what she’s thinking). She thinks we’re moaning myrtles! What she says is: I hear you, but…

Which is what people say when they really haven’t.

Here’s the thing.  I love my job. I know, bucket please. I’m aware it’s because I only do it part time, because I’m no-one’s boss, because I have awesome colleagues, and because I occasionally feel like I can help. Like my colleagues, I want to do it well. I know I can’t help as much as I’d like (I’d need a magic wand AND a crystal ball) but I can do my job while being positive and encouraging and reassuring and understanding.

But it takes time. To earn trust. To build a relationship. To give clear and concise information. Without sounding like a nag. And it’s emotionally draining. Pregnancy is such a worrying time for women (too much Google, hugely unhelpful); they are already convinced they are doing it all wrong, that they are terrible mothers. They aren’t.  They’re just run of the mill confused and tired and over-stimulated mums to be. So they have questions.

So. Many. Questions.

Some of them mind-bogglingly wierd! (Can I eat this soil, it’s from my homeland?) But first we have to dry the tears of anguish, wipe away the snot of despair, calm the ragged breathing of frustration. Then field the dodgy questions (absolutely not, I don’t care where it’s from) while trying to sound knowledgeable. THEN we can have the conversations we’re supposed to be having about vaccines and diet and breast-feeding. Oh dear lord, we seem to have run out of time… And that’s just standard. Simply because I asked how she was and then paused and made eye contact. So she lets it all out, all her fears, her worries, her hitherto hidden distress. Still, better a tsunami of tears than a subdued fine-thank-you. Because now I know something’s up but I’m going to need emotional tweezers to get her to share. She might tell me next time if I play my cards right. I’ll schedule her in for an extra appointment just to be sure.

It isn’t physically demanding,  unlike other aspects of midwifery. But it’s a heavy emotional burden for us to shoulder.

When we see women for their first appointment, we have more time. But in that initial appointment we have to impart a great deal of pregnancy information and also glean a good deal of sensitive information about her. Our sage advice will only be heeded if our soon-to-be mother trusts us.  She will only divulge the information we need if she trusts us. Failure to factor in enough time for that trust to be forged makes a mockery of the whole system. And yet, we don’t.  We are expected to do five initial visits on any given day.  On paper, ninety minutes is ample. In practice, women have been hoarding questions for weeks. Women always have complicated pasts,  unresolved issues, difficult life situations, and they all have real aspirations to be great mothers despite all these hurdles. But they will shut down like clams the moment they feel judged. Or hurried. Or just not heard. 90 mins is probably enough if it’s her second, assuming of course that she wasn’t traumatised by the first. When that’s the case, add 30 minutes just to debrief. While it is technically possible to do 5 initial visits in one day, the reality is that it is unsatisfactory for mother and midwife. We do three back to back in the morning, and two in the afternoon. Me, I’d be OK for my daughter/sister/niece to have the first, second or fourth (assuming the third didn’t overrun) appointment. The care will still be competent for the other 2 (or 3) appointments, but the midwife will be on autopilot, somewhat undercaffeinated, a little hypoglycaemic, a tad demoralised. As midwives, we are trained for endurance: we have the sturdiest of bladders, we can go for hours without refuelling, we can provide hours of back massages and breath coaching for a distressed labouring woman. We  can stay awake all night, we can calm frayed nerves. We can coax babies to feed, we can motivate mothers to push longer and stronger. So five appointments per day shouldn’t be such a biggie. But here’s the thing: on paper, you would see  questions which ought to have a yes/no answer and take 30 seconds to get through. In practice, even the simple question ‘are you allergic to anything?’ can elicit something like ‘well, I’m allergic to dust, and melons, and once, when I was a baby my mum says I got a rash after eating an egg but it hasn’t happened since and oh, yes, definitely pollen, I get terrible hay fever…’ fascinating as this all is, a no would have sufficed since I’m hardly going to be giving her intravenous melon, the labour ward is not dusty, I’m pretty sure she’s not allergic to eggs, and I can’t control the amount of pollen in the air. But she’s doing her best to answer the questions and I just have to gently rephrase the question to find out if she’ll get anaphylaxis from something I’m somewhat more likely to give her,  like antibiotics.

If I ask her about her mental health, she might tell me she’s anxious. So now I have to find out how anxious? Is it garden variety anxiety from excessive Googling? Does she need counselling? Is pregnancy making it worse? Or has she been hospitalised with full blown psychosis?

Does she have any sexually transmitted infections? Would she mind awfully if I tested her for three of them? I mean, sure, in ordinary circumstances she’d be properly counselled about the implications of getting these tests as a positive result would be pretty shocking information. But we have 90 mins and a lot to get through and, um, she wouldn’t want to infect the baby now, would she…

Ok, does she have a family history of inherited diseases? And no, I don’t need to know that great auntie Mildred had piles. Nor do I care if her MIL has diabetes as, however awful her husband’s mother might be, she cannot get gestational diabetes from her. I don’t actually need to know about that time she got a minor concussion or a couple of stitches or got stung by a wasp. But she’s trying to be helpful so it all comes out regardless.

And yet she probably won’t admit to being in an abusive relationship although I’ll ask her regularly throughout her pregnancy because she needs to know we can help, should she decide she trusts us enough to confide in us. Few women do: either that or the stats are wrong.

These are a snapshot of the questions we are dealing with 5 times a day. Many of the questions could open a  metaphorical can of worms…  It’s no biggie if each woman is Snow White (although… that girl’s got to have serious issues). And there are ways of asking sensitive questions that are much more likely to get to an honest answer. And ways to gloss over these difficult questions quickly. In both cases, we’ve asked. That box is ticked and we may or may not have had a chance to properly look inside the  wormy can because maybe she arrived late, or had difficult veins, or needed extra tests, or needed an interpreter, or brought her 2 year old who is bored and hungry, or she just didn’t want to tell us…

Midwives always care. We really do. But we’re not super human. Probably the hardest part of our job is figuring out how best to deploy our limited resources for maximum benefit. At least until we get time machines to conjure up extra hours. But for now, we have just 90 minutes. To ask her about every aspect of her entire life and try to prepare her for the upcoming upheaval that is pregnancy and motherhood. While establishing a trusting relationship. With women who have read terrible things about maternity care recently.

It’s actually quite a big ask.

We’d really love our big bosses to spend just one week with us because we suspect that they don’t really understand/have forgotten the emotional labour that we undertake. That’s obviously not going to happen  – they have their own burdensome workload. We know they’d deploy all their magic powers to conjure up more midwives, houses, money, decent jobs with fair maternity and paternity leave too, if only they were superhuman. They aren’t. So when they ask us how we’re doing, we do our best to explain even though it sounds like we’re whingeing. And they try to listen despite the fact it looks like they’re not. And nothing changes.